Please check which location/date you are registering for:

__	San Antonio	Saturday, September 7	Shearer Hills Baptist Church
__	McAllen	Sunday, September 8	Holy Spirit Catholic Church
__	Austin	Saturday, September 14	University Presbyterian Cnurch
__	Houston	Sunday, September 15	First Unitarian Church
__	Lubbock	Saturday, September 21	St. Paul's Episcopal Church
__	Dallas	Sunday, September 22	Northaven United Methodist Church

Please complete the following:

Name	_____________________________________________________________
Email	_____________________________________________________________
Street Address	_____________________________________________________________
City	_____________________________________________________________
Zip Code	_____________________________________________________________
Phone	_____________________________________________________________
Fax	_____________________________________________________________
*Faith/Denomination	_____________________________________________________________
*Congregation	_____________________________________________________________

*optional

Childcare will be offered for children 0-12 who are preregistered:

Child's name and age	_____________________________________________________________
Child's name and age	_____________________________________________________________
Child's name and age	_____________________________________________________________

(add other names on back)

Sign up for workshops and mealtime issue conversation tables will be on a first come/first serve basis at registration on the day of the Institute. To help us plan for demand, please indicate the issues in which you are most interested:

__	Child and Family Welfare: cash assistance, health care, child care, etc.
__	State Budget Issues
__	Death Penalty Reform
__	Other Criminal Justice Reform
__	Gambling
__	Ethics and Campaign Finance
__	Global Warming/ Air Pollution
__	Other Environmental Issues
__	Other: